Wednesday, September 6, 2017

APGARS, Unusual Surgeries, and Unfortunate Reactions to Vaccines

My rotation in the neonatal unit began on Friday. The attending physician adjusted my weeks in this rotation to begin on Fridays and end on the following Thursdays so that I could start the new rotation right away. I scrubbed in for an INCREDIBLY interesting surgical procedure performed on a child only a few hours old. I really wish I could describe it more, but I do not wish to have have a new parent google his child's condition only to find his own child's surgery described in detail in my blog.  

I didn't assist beyond helping to position the baby. He was under general anesthesia and as such, didn't need to be restrained or anything of the sort, but even an unconscious body doesn't necessarily remain exactly as positioned. It wouldn't have been appropriate for me to incise or to suture in this procedure because a newborn should not be under general anesthesia for ten seconds longer than is absolutely necessary, and students don't incise or suture as proficiently or as efficiently as real surgeons do. We, the rookies, must perfect our technique on larger humans before we advance to the newbies.

For the record, despite requiring surgery at such an insanely young age, the odds are that this baby will be fine. The condition necessitating the surgery was all that was wrong as far as anyone could tell. If nothing tragic happens during the procedure, the prognosis is typically quite good. I certainly hope everything turns out great for this little guy.

I've dealt with healthy babies to abstinence syndrome babies to babies with conditions requiring almost immediate surgery. I'm rapidly moving toward proficiency in APGAR scoring. APGAR scores are the rating scales applied to newborns (except possibly to some of the Duggars, who may not have anyone qualified to accurately rate them on hand when they were born) at one minute after birth, then again at five minutes. as you might have guessed, APGAR is an acronym, in this case standing for "Appearance, Pulse, Grimace, Activity, and Respiration." What you might not have guessed is that the term APGAR actually was the surname of Dr. Virginia Apgar, the New York  anesthesiologist who developed the scale, originally to be used as a method of quantifying the effects of anesthesia on infants. Ranking from one to ten by assigning from zero to two points for each criterion, a typical score for a thriving baby might be 8-9.  (My brother's score  was 9.10, which was at the time of his birth tied for the highest APGAR for any baby under seven pounds at the hospital where we were born. The record probably still holds, not that anyone other than my mother would be keeping track, as the odds of a kid under seven pounds knocking out consecutive tens is practically nonexistent.)

My weekly maximum hours were reached earlier in the week. I told the resident in charge of tracking our hours that I don't object to exceeding limits but that I won't falsify time sheets. It would be my luck that, were I to falsify times that I worked,  something significant, resulting in noting all personnel present,  would end up happening during one of my shifts, thereby calling attention to the false documentation on my time sheet. The residents are cut a certain amount of slack in exceeding students' duty hours. It is understood that some shifts need to be covered and that available personnel to cover shifts can be limited. The on-the-record reason for our presence is so that we may be adequately trained, but the practical purpose is sometimes for coverage of shifts. The scope of our duties is limited by our inexperience, but we can provide long stints of patient-monitoring when needed.

Because the attending physicians' and residents' primary concern is the well-being of their patients, as it should be. educating us is a secondary responsibility for them. It's one they signed up for when they accepted positions at a teaching hospital, but still they're wearing at least two hats most of the time that they work. My current attending physician and resident, as well as the ones I most recently worked with at the end of my gastroenterology rotation (This is going to make me sound like more of an airhead than I actually am, but I drew a complete blank when I attempted to recall what was my most recent rotation before the present one; I had to look back into my notes in order to remember what it was. This is like honest-to-God early-onset Alzheimers. So much for avoiding neurology at all costs because neurological conditions freak me out) have been awesome about trying hard to ensure that the med students' hours of duty were scheduled for times that would be most beneficial and would provide the best learning experiences. Many supervising residents tell students to show up at whatever times that make it easiest for the actual MDs. I've been most fortunate throughout most of my clerkship experience to have supervising residents who were considerate in that regard.

Flu shots were given today. Medical students need to take advantage of them in the absence of any compelling medical reasons to avoid them. I would have liked to ask to delay mine for a couple of months until my orthopedic situation has improved, but having a thoroughly messed up leg didn't legitimately disqualify me from receiving an injection in my upper arm. I now wish I had wimped out. I'm not actually ill, but my arm is swollen and painful to the extent that it's beyond the normal post-injection soreness and is considered a genuine reaction to the vaccine. My body doesn't handle injections all that well in general. Intramuscular shots in particular give me problems because my muscles are small. Often  the needles used are more suitable for arms larger than mine. If I'm being treated for an accident or injury with an injection, and if the serum has to be drawn or the syringe filled specifically for me, the nurse or whoever is filling it will most often look at my arm, then decide to use a syringe with a smaller needle. When vaccinations are being given in mass, whoever is giving the shot only rarely will bother. In the future I will be more insistent that such is indeed done. If I'm to be de facto forced into immunization, it will be with a needle that is the appropriate size for my puny body.

My upper arm is discolored and swollen. It feels worse than it looks. The discomfort is such that using my crutches is quite painful, but I don't yet have the option of walking without crutches. The current vaccine isn't a live virus, so actual flu symptoms following the vaccine are extremely unlikely though still possible. I'd rather be dealing with a sore arm than with even the most minor version of the flu, though, so all things considered, I'm probably lucky that my reaction is in the form of a sore arm. 

I've already put in seventy-one hours for the week, and I haven't had a day off since something like August 24. Because of my hours and because of my shot reaction, I've been kicked out of the hospital for the rest of this week (with my week ending on Thursday). Under more ordinary circumstances I might be hurt or insulted by the exclusion, but in my present situation I'm considering myself lucky. I've already dragged body up the stairs of the condo, so it's just a matter of putting my laptop on the floor, after which I will be ready for a deep state of unconsciousness and REM sleep.

Good night, all.


  1. This post is an interesting accompaniment to decision to watch ER.

    1. I enjoy ER though more for the interpersonal happenings than for the actual medical drama.

  2. Get some rest. When you're done with that take a nap.

    1. The nice thing about the lack of sleep in med school and residency is that, as long as we don't kill anyone in our states of sleep deprivation, it only gets better.